Presentation
Referred for thyroid FNA.
Patient Data
Hypoechoic, mildly irregular mass within the left lobe of the thyroid gland which demonstrates internal flow and calcification. Elsewhere the thyroid gland is homogeneous in echotexture with no further focal mass.
Numerous cervical lymph nodes are demonstrated bilaterally.
The left lobe of the thyroid is expanded by a low attenuation mass which demonstrates internal calcification. Elsewhere, the thyroid has a normal CT appearance. Numerous prominent and mildly enlarged lymph nodes are demonstrated on both sides of the neck. These are relatively symmetrical.
Case Discussion
The patient was submitted to US-guided FNA:
MICROSCOPIC DESCRIPTION: The smears contain dispersed atypical cells with round to oval, eccentric nuclei with stippled chromatin and a small amount of delicate cytoplasm. Occasional cells have intracytoplasmic granules and intranuclear pseudoinclusions. There are also scattered large cells with hyperchromatic, pleomorphic nuclei. Dense proteinaceous material is seen in the background. The atypical cells are Calcitonin, Chromogranin and Synaptophysin positive. CD56 is equivocal.
The smears contain a mixed population of lymphoid cells, dendritic reticulum cells and tingible body macrophages. The lymphoid cells show no nuclear atypia. No malignant cells are identified.
DIAGNOSIS:
- FNA left thyroid: Medullary carcinoma.
- FNA left level 3 lymph node: No evidence of malignancy.
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